Provider Demographics
NPI:1679505143
Name:HOPPER, ELIZABETH KAY (PHD)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:KAY
Last Name:HOPPER
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3 FROST ST
Mailing Address - Street 2:
Mailing Address - City:CAMBRIDGE
Mailing Address - State:MA
Mailing Address - Zip Code:02140-1502
Mailing Address - Country:US
Mailing Address - Phone:617-232-1303
Mailing Address - Fax:617-232-1280
Practice Address - Street 1:263 CONCORD AVE
Practice Address - Street 2:
Practice Address - City:CAMBRIDGE
Practice Address - State:MA
Practice Address - Zip Code:02138-1336
Practice Address - Country:US
Practice Address - Phone:617-232-1303
Practice Address - Fax:617-232-1280
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA8093103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAW51247Medicaid
MAW51247Medicaid